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Y. Yang



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    OA 16 - Treatment Strategies and Follow Up (ID 686)

    • Event: WCLC 2017
    • Type: Oral
    • Track: Early Stage NSCLC
    • Presentations: 1
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      OA 16.08 - A Modified Pathological N1 Classification Strategy Based on Systematic Dissection of N1 Nodes from Level 10 to 14 for Non-Small Cell Lung Cancer (ID 9157)

      14:30 - 16:15  |  Author(s): Y. Yang

      • Abstract
      • Presentation
      • Slides

      Background:
      It is necessary to apply a precise standard to predict the oncological outcomes among heterogeneous subgroups of N1 disease ranging from level 10 to 14. Although International Association for the Study of Lung Cancer (IASLC) proposed a new N descriptor in the 8[th] edition of the TNM Classification, lack of dissection on level 13 and level 14 may affect the efficacy of new classification. In this study, we tested a hypothesized classification strategy based on systematic dissection of N1 node from level 10 to level 14.

      Method:
      From March 2007 to December 2014, 156 consecutive patients of non-small cell lung cancer, treating with lobectomy and systematic mediastinal lymphadenectomy, were investigated. Nodes from level 10 to 12 were dissected during operation. Intrapulmonary lymph nodes (level 13-14) were retrieved after surgery. The data were prospectively collected and retrospectively analyzed. All cases were divided into two categories according to the 8[th] edition of the TNM Classification: pN1a was defined as N1 at a single station, while pN1b was defined as N1 at multiple stations. Then, in our proposed classification, N1a (modified) was defined as single level of N1 station involved (not including single level 10 or 11 spread) or level 13 and/or 14 involved, while N1b (modified) was defined as single level 10 or 11 spread or multiple levels of N1 node involvement (not including level 13 and 14 spread). The association between the N1 subgroup status and survival was explored separately using 8[th] IASLC classification and hypothesized classification.

      Result:
      In the whole cohort, a mean±SD of 13.1±7.1 N2 nodes and 12.0+5.2 N1 nodes per case were collected.There were 4.7±3.1 nodes from level 13 and 14. The difference in 5-year overall survival between pN1a and pN1b was not significant (73.9% versus 65.7%, p=0.371). However, the difference in 5-year overall survival between N1a (modified) and N1b (modified) was significant (79.1% versus 60.2%, p=0.018). Multivariate analysis showed the revised N1 classification was an independent prognostic factor for NSCLC (versus N1a, the hazard ratio [HR] of N1b for OS was 2.120, 95% confidence interval [CI]: 1.083-4.151, p=0.028). However, the 8[th] edition IASLC N1 descriptors was not an independent prognostic factor (versus pN1a, HR of pN1b was 1.419, 95% CI: 0.710-2.837, p=0.322).

      Conclusion:
      The hypothesized N1 classification in present study was shown to be a better descriptor to express the outcome than 8[th] edition of the TNM Classification of IASLC. More data are needed to validate this proposal.

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    P1.14 - Radiotherapy (ID 700)

    • Event: WCLC 2017
    • Type: Poster Session with Presenters Present
    • Track: Radiotherapy
    • Presentations: 1
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      P1.14-004 - Outcomes of Stereotactic Body Radiotherapy and Surgery in Treating Early Stage Non-Small Cell Lung Cancer: A Meta-Analysis (ID 7399)

      09:30 - 16:00  |  Author(s): Y. Yang

      • Abstract

      Background:
      To provide a promising option for early stage non-small-cell lung cancer (NSCLC) treatment, a meta-analysis of stereotactic body radiotherapy (SBRT) and surgery in lung cancer was carried out.

      Method:
      Literatures were retrieved from the databases of PubMed, Embase and the Cochrane library and qualities were assessed by Nine Stars System Scale. All of the statistical analyses were conducted using Stata 11.0. Risk ratios (RRs) with its 95% confidence interval (CI) were set as effective indicators. Heterogeneity was estimated by Q statistics and I[2], and the publication bias was evaluated by Egger test.

      Result:
      A total of 12 high-quality studies were enrolled in this study (Table 1). No significant difference was identified in 1-year overall survival (OS) rate between SBRT and surgery. An obvious higher 3-year OS rate was detected in surgery compared with SBRT (RR = 0.78, 95% CI: 0.63 - 0.97). Moreover, superior 5-year OS rates were also identified in surgery (RR = 0.69, 95% CI: 0.52 - 0.91) and lobectomy (RR = 0.58, 95% CI: 0.47 - 0.72) compared with SBRT. The 3-year loco-regional recurrence control rate in SBRT was remarkably higher than that in surgery (RR = 1.11, 95% CI: 1.01 - 1.22), but the pooled 5-year distant recurrence control rate of SBRT was markedly lower than that in surgery (RR = 0.87, 95% CI: 0.76 - 0.99). Table 1 Characteristics of the included studies.

      Study Year Country Duration Design Stage Follow up time Treatment Sample size Male/Female Age (years) Outcomes
      Chang 2015 Multi centers 2008- 2014 RCT I 40.2 months SBRT 31 14/17 67.3 (9.2) 1y SR; 3y SR; 3y DCR
      35.4 months Surgery 27 11/16 67.3 (8.2)
      Crabtree 2010 USA 2000- 2007 RCS I 5 years SBRT 57 NA 71 (50-94) 3y SR
      Surgery 57 NA 73 (47-90)
      Crabtree 2014 USA 2004- 2010 RCS I 5 years SBRT 56 29/27 70.7 (10.6) 1y SR; 1y DCR; 3y SR; 3y DCR; 5y SR; 5y DCR
      Surgery 56 32/24 70.0 (8.1)
      Hamaji 2015 Japan 2003- 2009 RCS I 40.7 months SBRT 41 31/10 73 (58-85) 3y SR; 5y SR
      54 months Lobectomy 41 32/9 74 (61-86)
      Matsuo 2014 Japan 2003- 2009 RCS I 6.7 years SBRT 53 42/11 76 (58-86) 5y SR; 5y DCR
      5.3 years SLR 53 37/16 76 (50-88)
      Mokhles 2015 the Netherlands 2003- 2012 RCS I 28 months SBRT 73 42/31 67 (10) 1y SR; 1y LGR; 1y DCR; 5y SR; 5y LGR; 5y DCR
      49 months Lobectomy 73 44/29 67 (9)
      Palma 2011 the Netherlands 2005- 2007 RCS I 43 months SBRT 60 40/20 79 (76–81) 1y SR; 3y SR
      Surgery 60 40/20 79 (76–80)
      Paul 2016 USA 2007- 2013 RCS I 6.25 years SBRT 201 76/125 76.9 (6.1) 3y SR
      SLR 201 78/123 76.8 (6.0)
      Puri 2015 USA 1998- 2010 RCS I 36.5 months SBRT 5355 2407/2948 74.3 (8.5) 3y SR
      36.5 months Surgery 5355 2382/2973 74.2 (8.4)
      Varlotto 2013 USA 1999- 2008 RCS I 25.8 months SBRT 72 NA 73.3 3y SR; 3y LGR; 5y SR; 5y LGR
      Lobectomy 72 NA 68.6
      SBRT 17 NA 73.3 3y SR; 3y LGR; 5y SR; 5y LGR
      SLR 17 NA 67.5
      Verstegen 2013 the Netherlands 2007 RCS I–II 60 months SBRT 64 37/27 70.5(9.9) 1y SR; 1y LGR; 1y DCR; 3y SR; 3y LGR; 3y DCR
      48 months Lobectomy 64 36/28 67.9 (8.8)
      Wang 2016 China 2002- 2010 RCS I 58.7 months SBRT 35 33/2 77.1 (5.2) 1y SR; 1y LGR; 3y SR; 3y LGR; 5y SR; 5y LGR
      Surgery 35 33/2 74.8 (6.6)
      RCT, randomized controlled trial; RCS, Retrospective cohort study; SBRT, Stereotactic body radiotherapy; SR, survival rate; SLR, sublobar resection; DCR, distant control rate.

      Conclusion:
      SBRT might have a superior loco-regional recurrence control in early stage of NSCLC, but the OS rate was lower than that in surgery. However, well-designed investigation with a larger sample was still need to verify and update this conclusion.

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    P2.01 - Advanced NSCLC (ID 618)

    • Event: WCLC 2017
    • Type: Poster Session with Presenters Present
    • Track: Advanced NSCLC
    • Presentations: 1
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      P2.01-068 - Lobectomy Improve the Survival of Non-Small Cell Lung Cancer Patients with Occult Malignant Pleural Disease First Detected at Thoracotomy (ID 9131)

      09:00 - 16:00  |  Author(s): Y. Yang

      • Abstract
      • Slides

      Background:
      To aim of this study was to determine the clinical and biological prognostic factors for occult malignant pleural disease (MPD) first detected at thoracotomy in patients with non-small cell lung cancer (NSCLC) and evaluate the results of surgical intervention.

      Method:
      A total of 123 patients diagnosed with MPD at consecutive 2894 thoracotomy from January 2006 to October 2016. Clinical and pathological characteristics were evaluated in 120 patients. Survival curves were estimated by the Kaplan–Meier method, and Cox regression analysis was performed to validate the selected risk factors.

      Result:
      With a median follow-up of 34 months, the 5-year overall survival of 120 patients was 28%. Multivariate analyses using the Cox proportional hazards model showed gender (p=0.066), T stages (p<0.001), N stages (p=0.032), pleural invasion in image (p=0.004), pleural effusion (p=0.027), surgery intervention (p=0.024) and EGFR status (p=0.001) were independent predictors of survival. The 5-year survival rate and median survival time (MST) for 21 patients with lobectomy were 71.6% and 62.6 months, compared with 25.6% and 40.0 months in 46 patients with sublobectomy. When 53 patients subjected to open-close surgery, their 5-year survival rate and MST were 23.4% and 30.2 months. There was significant prognostic difference between lobectomy and sublobectomy /open-close surgery (p=0.033/0.016), but no significant difference was found between sublobectomy and open-close surgery (p=0.679) Figure 1



      Conclusion:
      Lobectomy confers better prognosis compared to sublobectomy and exploratory thoracotomy for occult MPD patients with NSCLC.

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